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General NPI Number Information
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NPI Number | 1528607629
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Entity Type | Individual
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Provider Name | JESSICA GHERMEZI
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Gender | Female
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 3101 OCEAN PARK BLVD STE 100
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City | SANTA MONICA
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State | CA
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Zip | 90405-3029
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Country | US
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Telephone | 310-402-1564
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 OCEAN PARK BLVD STE 100
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City | SANTA MONICA
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State | CA
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Zip | 90405-3029
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Country | US
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Telephone | 310-402-1564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 4402
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License Number State | CA
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